The Arthritis History for a NEW PATIENT

Developed by Andy Thompson MD FRCPC

Welcome to your rotation in Rheumatology at St. Josephs Health Care Centre. We look forward to teaching you
about arthritis and the rheumatic diseases.
INTRODUCTION
Arthritis is often a little mysterious and the history and physical examination can be overwhelming. Given this, it can
be very difficult for a trainee to capture relevant information necessary for a diagnostic and treatment plan. In
general, when rheumatologists approach a new patient with arthritis the following questions are going through their
mind:
1. Is this an inflammatory or non-inflammatory arthropathy?
2. What is the burden of this disease?
a. Joint involvement?
b. Is there joint damage?
c. Constitutional features such as fatigue or sleep disruption?
d. Effect on daily living?
3. Are there extra-articular features of the disease?
4. What previous treatments used and how they have worked or not worked?
5. What prior investigations have been performed that may help with the diagnosis?
6. Is there evidence on physical examination to support the historical features?
7. What further investigations need to be performed?
8. What is an appropriate treatment regimen?
Below is an approach to taking an arthritis history from a patient. It is divided into questions followed by information
gathered from the questions and the relevance of the information. It is very important to understand why you are
asking the question and what you will do with the information you receive.

DEMOGRAPHIC DATA

QUESTION: What is your sex and age?

INFORMATION GATHERED

o It is very important to determine a patients age and sex as they can be helpful in a patients diagnosis. For
example, a diagnosis of gout presenting in a young woman would be very unusual unless she had other
risk factors. Similarly a new diagnosis of ankylosing spondylitis in an 80 year old man is very unlikely as
well.

PRESENTATION & PROGRESSION OF THE ARTHRITIS

QUESTION: When did you first notice your arthritis?

INFORMATION GATHERED

o When was the initial onset of the arthritis? This question is a very important prognosticator. A patient with
long-standing arthritis with little disability, no damage or deformity will likely do better than a similar patient
with significant damage and deformity. This works well for patients who have had arthritis for a while but is
not as useful for those with recent onset arthritis.

QUESTION: When your arthritis first started, where did it hurt and what joints did it start in?
INFORMATION GATHERED

o What was the initial pattern of the joint involvement? This is very important in distinguishing an
inflammatory pattern from a degenerative pattern from pain caused by peri-articular structures. For
example, if a patient said the arthritis began in my hands this could mean a lot of things. It could mean
MCP, PIP, DIP, wrist involvement, carpal tunnel syndrome, tenosynovitis etc. If the arthritis started in the
elbows it could mean true elbow involvement or epicondylitis and similarly if it started in the feet the
patient could be referring to plantar fasciitis or an Achilles tendonitis. The point be very specific when
asking.

o IMPORTANT POINT: Primary Osteoarthritis does not involve the MCPs, Wrists, Elbows, Shoulders,
Ankles, or 2-5 MTPs. Arthritis involving these joints is either Secondary Osteoarthritis (Secondary to
previous trauma, infection etc) or it is an Inflammatory Arthritis.
o The number of joints involved at the beginning.
Monoarthritis (1): Typically the way osteoarthritis begins especially if it is in a lower extremity
weight bearing joint. However, an inflammatory arthritis may begin as a monoarthritis as well.
Oligoarthritis (1-4): Can be an early presentation of an inflammatory arthritis but may also
represent a degenerative process.
Polyarthritis (>4): Usually associated with an inflammatory arthritis.
Osteoarthritis

Rheumatoid Arthritis

Psoriatic Arthritis

QUESTION: How long did it take for your arthritis to first start?

INFORMATION GATHERED
o The pattern of onset of the arthritis:
Acute Onset (Overnight-Days): It is unusual for a degenerative problem to being suddenly out
of the blue unless there has been some aggravating event (i.e. trauma). Inflammatory arthritides
that often begin acutely include crystalline arthropathies, infectious arthritis, and reactive arthritis.
Other inflammatory types of arthritis usually begin a little bit more insidiously but we still do see
acute presentations from time to time.
Subacute Onset (Weeks): This is a more typical presentation for an inflammatory arthritis. The
most common pattern is one which slowly adds more joints over time. It might begin in the hands
and then over a period of weeks begin to add other joints such as wrists, knees, ankles, feet etc.
This is known as the additive pattern.
Chronic Onset (Months to Years): This is a more typical presentation for a degenerative type of
arthritis. The only caveat is sometimes patients with inflammatory arthritis have not had an early
diagnosis and their arthritis has progressed for some time.
QUESTION: How has your arthritis progressed and what joints does it involve now?
INFORMATION GATHERED
o The pattern of progression of the arthritis

Unchanged from the Onset: The arthritis began and has not affected any more joints. This
would be more typical for a degenerative type of arthritis.
Additive Pattern: Again, this begins with joints becoming progressively added over time. The
patient might say, It began in my right wrist and then two weeks later my hands became swollen,
stiff, and sore and then about a week later my knees became stiff and sore. This is very typical
for the progression of an inflammatory arthritis.
Palindromic Pattern: The begins with a joint becoming involved and reaching peak intensity over
24 hours and then resolving just as quickly as it came on. This pattern of progression is found to
be bizarre by most patients. A patient might say, My knee started to hurt on Saturday and on
Sunday I couldnt walk and then by Monday it felt fine again.
SIDE NOTE: A palindrome is a word that is the same coming as going. For example, the
word racecar is the same when spelled forwards or backwards! Cool! Palindromic
arthritis is the same coming as going; in other words, it comes on quickly and leaves
quickly.
Intermittent Pattern: Some inflammatory arthritides can come intermittently affecting a joint or
joints for some time before settling down and then affecting another joint.
o The pattern of joint involvement now
Again, as above is the pattern Inflammatory or Degenerative see diagrams above.
o The number of joints which are now involved.
Monoarthritis (1)
Oligoarthritis (1-4)
Polyarthritis (>4)

INFLAMMATORY FEATURES OF THE ARTHRITIS

QUESTION: Do you notice swelling in your joints?
INFORMATION GATHERED
o Swelling in the joints can be indicative of an inflammatory problem. Osteoarthritis can also be associated
with swelling but it may not be as dramatic as swelling with an inflammatory arthritis.
o Be specific when you ask this question. If the patient tells you that their hands swell then ask them exactly
where and what joints. Is it the DIPs, PIPs, MCPs, wrists, extensor or flexor tenosynovium, or just the
whole hand in general?
o Patients with Fibromyalgia will also complain of swelling in the joints. For example, they might complain of
swelling of the whole hand. If you press on and ask them, in particular, what joints in the hand swell they
will usually not be able to point to specific joints. That being said, inflammatory arthritis can also do the
same but it is important to try to distinguish.
QUESTION: Do your joints become warm to the touch?
INFORMATION GATHERED
o This question is tricky because flaring osteoarthritis and the joints involved in an inflammatory arthritis may
both be mildly warm.
o Hot joints are usually associated with redness and seen with infection, gout, and reactive arthritis.
QUESTION: Do your joints turn colours such as pink or red?
INFORMATION GATHERED
o Arthritic conditions where the joints turn bright red (usually very painful): Infection, Gout, Reactive Arthritis,
and sometimes Psoriatic Arthritis when it is very acute although this is very rare.
o The joints of patients with other types of inflammatory arthritis DO NOT turn red unless something else is
going on. Patients with rheumatoid arthritis may notice their joints becoming purple.
o The joints of patients with osteoarthritis DO NOT turn red unless something else is going on.

DIURNAL PATTERN OF THE ARTHRITIS

QUESTION: When you wake up in the morning do your joints feel stiff and sore?
INFORMATION GATHERED

o Almost every person with arthritis will feel stiff and a little sore in the morning.
o It is important to try and distinguish between pain and stiffness.
QUESTION: How long does it take for you to feel as best as you are going to feel for the rest of the day?
INFORMATION GATHERED

o Patients with Osteoarthritis can have morning stiffness that usually lasts 15-30 minutes.
o Patients with inflammatory arthritis will have prolonged morning stiffness which lasts at least one hour. As
a patient rests or sleeps inflammation continues with inflammatory fluid building up in and around the
joints. When the patient wakes up to get going this buildup of fluid makes them feel stiff. As they get
moving the fluid is eventually reabsorbed (lymphatics & venous) and the patient feels looser.
QUESTION: Where do you feel the morning stiffness?
INFORMATION GATHERED

o Patients with inflammatory arthritis can feel stiff all over but can usually tell you that the stiffness is
confined to joint areas. Patients with Fibromyalgia will also complain of morning stiffness but it is more
generalized complaining of stiffness from head to toe in muscles and in joints.
QUESTION: Do you ever have days when you have no morning stiffness?
INFORMATION GATHERED

o Patients with inflammatory arthritis usually have some degree of morning stiffness everyday. Their disease
does fluctuate and therefore the degree of morning stiffness will as well but it is usually present in some
capacity.
o Patients with fibromyalgia may say that they feel stiff and sore for 4 days out of the week and the other 3
they have no morning stiffness at all. This would be an unusual pattern for a true inflammatory arthritis.
QUESTION: Is your arthritis usually better or worse as you get moving/ with activity?
INFORMATION GATHERED

o Patients with osteoarthritis will inevitably become worse as they use the involved joint.
o Patients with inflammatory arthritis will usually become better as they get moving. However, if they do too
much they can become worse towards the end of the day. I call this a bimodal diurnal pattern. Patients
with longer standing inflammatory arthritis may have accompanying secondary degeneration causing them
to become worse as they use their joints.
Patterns of Stiffness and Soreness in Inflammatory Arthritis throughout the day:
Bimodal Pattern

Time

Unimodal Pattern

Time

Continuous

Time

CONSTITUTIONAL FEATURES
QUESTION

o Has your energy level changed?

INFORMATION GATHERED
o Any painful condition can have an impact on energy levels and the perception of energy as patients work
with the pain.

o Patients with inflammatory arthritis and connective tissue diseases notice a reduction in their energy level
and associated fatigue. In particular, some patients (especially those with SLE) can discern fatigue from
their illness from fatigue due to other causes.
o All patients with fibromyalgia have low energy.
o Patients with osteoarthritis should have normal to slightly lower energy as well.
QUESTION

o How well do you sleep at night and do you feel refreshed when you wake in the morning?
INFORMATION GATHERED
o Is the sleep at night comfortable or uncomfortable and why so.
o Is the sleep continuous or interrupted?
Bad bed partner
Pain from arthritis
Up to the bathroom
o Is the sleep restorative or non-restorative?
Sleep which is non-restorative can make coping with day to day life (especially when in pain) very
difficult. When fatigued, pain can be perceived at a higher level.
QUESTION

o Do you have any fevers or chills?

INFORMATION GATHERED

o Fevers should not be seen with osteoarthritis.

o It is unusual to have a fever accompany an otherwise uncomplicated inflammatory arthritis. If a patient
with an inflammatory arthritis develops a fever think of infection first, especially if they are taking
immunosuppressive medications.
o Fevers are more commonly seen with diseases such as Infectious Arthritis, Gout, Adult Onset Stills
Disease, Lupus etc.
QUESTION

o Have you lost any noticeable weight?

INFORMATION GATHERED
o Weight loss can be a part of the presentation of an inflammatory arthritis.
o Otherwise patients usually report weight gain due to immobility.

SOCIAL & FUNCTIONAL INQUIRY

QUESTION

o Are you able to perform your normal activities of daily living independently?
Personal Hygiene
Can you dress yourself?
Can you bathe yourself?
Can you groom yourself?
Household Chores
Can you cook your meals?
Can you clean the house?
Can you shop for food?
Mobility
How far can you comfortably walk?
How long can you comfortably stand?
Can you drive a car?
Employment
Are you able to work?
What type of work do you do?
Have you taken any time off work because of your arthritis?

Social Support
Who do you live with?
Do you have family nearby who can help you?
What other supports do you have?
INFORMATION GATHERED
o When treating patients with arthritis it is very important to determine their level of functioning.
We know that people who present with a significant reduction in their normal functioning tend to do
worse over time.
When we are treating arthritis we are looking for a meaningful improvement in the level of
functioning.
Rheumatologists often use a tool known as a Health Assessment Questionnaire or HAQ to
determine the level of disability in their patients. The HAQ is often accompanied by 10 cm scales
pertaining to sleep, fatigue, pain, and overall global health.
An employment history is essential. Did you know that 50% of patients with RA will not be working
10 years from the initial diagnosis? It is important to address vocational issues early in the
disease course so vocational counseling can begin immediately. A patient with RA with a manual
labour job will might not fair as well as if the patient worked in an office with less physical demand
on his or her joints.

QUESTION: Have you had to give up any activities because of your arthritis?
INFORMATION GATHERED

o Patients function at all different levels. Some patients may be able to perform all of their activities of daily
living but have had to give up other activities. Imagine an Olympic caliber volleyball player who can
function quite well day to day but has had to give up volleyball. This also has a serious impact on this
persons life.
QUESTION: Do you smoke?
INFORMATION GATHERED

o Smoking can have an adverse effect on arthritis in the following ways:

Smokers are less likely to respond to medications (e.g. Plaquenil in SLE)
Smokers can have worse disease (e.g. More rheumatoid nodules)
Smokers have an increased risk of cardiovascular disease

QUESTION: How much alcohol do you drink?

INFORMATION GATHERED

o It is important to determine alcohol consumption as it can interact unfavourably with some of the
medications used to treat the rheumatic diseases.
QUESTION: Are you employed or on disability?
INFORMATION GATHERED

o This is also a very important question. Patients who are on disability are not likely to return to work and
tend to do worse than patients who manage to keep working.

QUESTION: Do you have private medical insurance?

INFORMATION GATHERED

o Given the cost of medications it is important to determine if patients have assistance in paying for them.

QUESTION: Financial difficulties?

INFORMATION GATHERED

o Very important when prescribing medications as some medications can be very expensive

QUESTION: Sexual Health Issues?

INFORMATION GATHERED

o This issue is usually left until you know the patient a little better and feel comfortable discussing issues
about sexual health as it pertains to patients with arthritis.

RHEUMATOLOGIC & GENERAL REVIEW OF SYSTEMS

The review of systems in rheumatology serves three purposes:
1. To gather evidence pertaining to risk factors for diseases
2. To gather evidence pertaining to associated factors for diseases
3. To obtain further evidence of other medical problems
General Review of Systems

o Heart Disease
o Pulmonary Disease
o Renal insufficiency
o Hepatic problems
o Neurologic problems
o Special Sensory problems Vision & hearing
Are there any Clues to suggest this might be Infectious?
o Bacterial
Usually just monoarticular very red and warm joint
Associated Fevers and Chills
Portal of entry skin wound, chest, urine, diarrheal illness
Prior underlying joint abnormality prosthetic joint, RA, OA
o Viral
Usually acute polyarticular onset
Known exposure to parvovirus
May have an associated rash Parvovirus
Duration less than 6 weeks
Other people sick at home
Hepatitis & HIV
Sexual transmission, blood transfusions, tattoos, IVDU
Known hepatitis B or C
Known HIV
o Sexually transmitted
Sexual history
Genital sores or discharge
Other Rashes
Fevers/Chills
o Other
History of travel
Are there any Clues to suggest this might be RA?
o Risk Factors
Strong family history?
o Associated Symptoms
Rheumatoid Nodules?
Sicca Features?
Raynauds Phenomenon?
Ocular Inflammation?
Pulmonary Involvement?
Carpal Tunnel Syndrome?
Are there any Clues to suggest Seronegative Spondyloarthritides?
o Psoriasis or Family history of Psoriasis?
o Nail Changes?
o Other Rashes Reactive arthritis?

o History or Family history of Inflammatory Spinal Disease?

o Prodromal Diarrheal or Urinary Tract Infection?
Usually occurs 10-14 days preceding the onset of arthritis but can be up to 4 weeks afterwards.
o Predominant Lower Limb Involvement?
Can be a feature of reactive arthritis, Ankylosing spondylitis, and arthritis associated with IBD
o Symptoms to suggest Inflammatory Bowel Disease?
o History or Entheseal Pain (Achilles, Plantar Fasciitis, patellar tendonitis, rotator cuff tendonitis, costochondritis
etc)?
o History of Dactylitis (Sausage like digit)?
o History of Ocular Inflammation?
o Carpal Tunnel Syndrome?
Are there any Clues to suggest a Connective Tissue Disease?
o Alopecia
o CNS Symptoms
Headaches
Psychiatric Illness
Other neurologic illness
o PNS Symptoms
Neuropathy
o Oral or Nasal Ulceration, nosebleeds, or chronic sinusitis
o Lymphadenopathy
o Skin Rashes
Malar Rash
Photosensitive Rash
Other Rashes
o Raynauds Phenomenon
o Pulmonary Problems
Pleuritic Chest Pain
New onset SOB
New onset Cough
o Cardiac Problems
o Gastrointestinal Problems
o Renal Problems
Known renal disease
New onset hypertension
Hematuria
Proteinuria
o Miscarriages
o Blood Clots
Are there any Clues to suggest Crystalline Arthritis?
o Gout
Past history of gout / family history of gout
Diuretic use
Alcohol abuse
Renal Calculi or renal insufficiency
Hypothyroidism, hyperparathyroidism
Associated with hypertension, obesity, insulin resistance, hypercholesterolemia
Are there any Clues to suggest a Degenerative Pattern?
o Genetic Family History
o Advanced age
o Obesity lower extremity OA
o Female gender
o Prior trauma

MEDICATION SAFETY ASSESSMENT

This can often be done during a review of systems and social history. In rheumatology, there are a number of
medications used which can have adverse effects. It is very important to document prior medical problems to reduce
the frequency of adverse medication related events. Specifically, the following should be addressed:
Risk Factors for Peptic Ulcer Disease The risk of peptic ulceration in RA is higher than the general population.
o Prior History of an ulcer or GI bleed of any type
o Concurrent use of anticoagulants Coumadin
o Heavy use of Alcohol
o Concurrent use of steroids
Evaluation for Cardiac Disease This is important for a few reasons:
o Patients with chronic inflammatory diseases (RA & SLE) have an increased risk of coronary artery
disease. It is important to control all modifiable risk factors to improve survival.
Smoking
Diabetes
Cholesterol
Weight Exercise programs & diet
Hypertension
o Congestive heart failure Some medications may make this worse
Corticosteroids
NSAIDs
Biologics
o Atherosclerotic disease Some medications might make this worse (controversial)
COXIBs
Estrogens
Evaluation for Liver Disease Important to ask as many of our medications (methotrexate) are hepatotoxic and
many others are metabolized hepatically.
o Alcohol intake, Hepatitis
NSAIDs
Methotrexate
Azathioprine
Leflunomide
Sulfasalazine rare
Evaluation for Renal Disease Important to ask as some of our medications may be nephrotoxic while many
others are renally excreted.
Pregnancy & Lactation Many of our medications are absolutely contraindicated in pregnancy and lactation. It
is VERY important to discuss pregnancy and lactation plans with all patients (particularly women) of child bearing
potential.

PREVIOUS INVESTIGATIONS

This is self explanatory and the investigations should be recorded.

PREVIOUS TREATMENTS
It is imperative to ask about previous treatments. I find that many residents and students ask about previous
treatments but dont ask if they worked or not. A common scenario is as follows:
Patient: I took the methotrexate but it didnt work and they stopped it
Physician: How long did you take it for?
Patient: About 4 weeks
Physician: How many tablets did you take a week?
Patient: About 3
Physician: Did you have any side effects

Patient: No
Clearly in this case the patient was not given a proper dose or duration of Methotrexate to see if it was efficacious or
not. The methotrexate was stopped prematurely. This patient was restarted on appropriate doses of methotrexate
and for an appropriate length of time and it worked for her. When asking about medication I always ask what they
were on and then how well it worked. For example, Rate for me on a scale of 1 to 10 how well the naproxen worked
for you?, or Would you say that the naproxen helped you 10%, 50% or 90%? Both of these scales give good
indications of how well the treatment worked.
Non-Pharmacologic

o Physiotherapy
o Occupational Therapy
o Chiropractor
o Massage
Pharmacologic
o Analgesics
o NSAIDs
o DMARDs
o Steroids
o Biologics

FAMILY HISTORY

A family history of arthritis can be very useful. Most inflammatory arthritides do not tend to have as strong a familial
history as osteoarthritis. Below is an example of diseases and their family histories:

Adult Stills Disease Familial cases are exceedingly rare.

Ankylosing Spondylitis A first degree relative with AS increases the risk to 5-20%.
Behcets Disease Familial cases are exceedingly rare.
Calcium Pyrophosphate Deposition Reported familial/hereditary forms of CPPD.
Churg Strauss Syndrome No familial association.
Complex Regional Pain Syndrome No familial association.
Diffuse Idiopathic Skeletal Hyperostosis May be a genetic component as there is a particularly high prevalence
of DISH in the Pima Indians in Arizona, USA.
Fibromyalgia More common in family members with FM.
Gout Familial cases are common and an independent risk factor for gout.
Inflammatory Muscle Disease No familial association.
Microscopic Polyangiitis No familial association.
Mixed Connective Tissue Disease No familial association.
Neuropathic Arthropathy Family history of diabetes.
Osteoarthritis Familial cases are very common with heritability of primary OA of the hands reported in as many
as 65% of cases.
Osteoporosis Family history is very common with osteoporosis and family history of a fracture is a major risk
factor for future history of a fragility fracture.
PMR/GCA There is a slightly higher risk for patients with siblings with GCA.
Polyarteritis Nodosa No associated family history
Psoriatic Arthritis A 50 fold increase for first degree relatives with psoriatic arthritis. Fathers are twice as likely to
transmit the disease. Monozygotic twins have a 70% concordance rate.
Reactive Arthritis May be a small increased risk given the passage of HLA-B27
Relapsing Polychondritis No associated family history
Rheumatoid Arthritis Does not frequently aggregate in families, however, familial cases are well reported.
Sjogrens Syndrome An increased risk is present among family members.
Systemic Lupus Erythematosus An increased risk with 5-12% of family members having SLE.
Systemic Sclerosis There are reported clusters but these are extremely rare.

 Takayasu Arteritis Very rare (case reports) of familial clusters.

Wegeners Granulomatosis No associated family history.

SUMMARIZING THE HISTORY

After completing a relevant arthritis history it is often very useful to summarize your history. The physical examination
is then performed to provide further evidence for the disease in question.

FORMULATION OF A DIFFERENTIAL DIAGNOSIS:

After summarizing the history it is important to formulate an initial differential diagnosis prior to the physical
examination. This is an important step as it is can be a useful guide to focus your examination. For example, the
physical examination of a patient suspected of having a connective tissue disease will be different from a patient
suspected of having OA of the knee.

ARTHRITIS DIFFERENTIAL
1.

Infectious Arthritis
a. Viral
i. HIV, hepatitis B/C, Parvo B19, EBV, Rubella
b. Bacterial
i. Gonococcal
ii. Non-Gonococcal
a. Gram positive (75-80%)
b. Gram negative (20-25%)
ii. Rickettsia
iii. Mycoplasma
c. Rheumatic Fever
d. Bowel Bacterial Overgrowth
e. SAPHO
f. Mycobacterium
i. Tuberculosis
g. Fungal
i. Coccidioidomycosis
ii. Sporotrichosis
iii. Blastomycosis
iv. Cryptococcus
v. Histoplasmosis
h. Spirochetes
i. Borrelia Burgdorferi (Lyme)
ii. Treponema Pallidum (Syphilis)

2.

Crystalline Arthropathies
a. Monosodium Urate Deposition (GOUT)
b. Calcium Pyrophosphate Deposition (CPPD)
c. Basic Calcium Phosphate Deposition

3.

Rheumatoid Arthritis & Variants

a. Rheumatoid Arthritis (RA)
b. Juvenile Inflammatory Arthritis (JIA)
c. Adult Stills Disease (ASD)

4.

Seronegative Arthritides
a. Psoriatic Arthritis (PsA)
b. Ankylosing Spondylitis (AS)
c. Reactive Arthritis (ReA)
d. Enteropathic Arthritis (EA)
e. Undifferentiated Spondyloarthropathy

5.

Connective Tissue Diseases

a. Systemic Lupus Erythematosus (SLE)
b. Sjogrens Syndrome (SS)
c. Inflammatory Myopathies (PM/DM)
d. Systemic Sclerosis (SSc)
e. Overlap Syndromes
f. Mixed Connective Tissue Disease (MCTD)
g. Undifferentiated CTD (UCTD)
h. Relpasing Polychondritis (RP)
i. Behcets Disease (BD)
j. Vasculitides
i. Large Vessel
ii. Takayasu Arteritis (TA)
iii. Giant-Cell Arteritis (GCA)
k. Medium Vessel
i. Polyarteritis Nodosa (PAN)
ii. Kawasakis Disease (KD)
iii. Isolated CNS vasculitis
l. Small Vessel

i.
ii.
iii.
iv.
v.
vi.
vii.

Hypersensitivity Vasculitis (drugs, infection)

ANCA associated (WG, CSS, MPA) vasculitis
Cryoglobulinemic vasculitis
Henoch Schonlein Purpura (HSP)
Vasculitis secondary to CTD
Malignancy associated vasculitis
Vasculitis mimics - Sepsis

6.

Degenerative Arthritides
a. Primary Osteoarthritis
b. Secondary Osteoarthritis
i. Hereditary -Type II collagen defect
ii. Mechanical - Post traumatic
iii. Metabolic - Hemochromatosis (HC), CPPD
iv. Neurovascular (see below)

7.

Arthritis Associated with Systemic Disease

a. Sarcoidosis
b. Metabolic
i. Hemochromatosis
ii. Wilsons
iii. Amyloidosis
iv. Lipids
c. Endocrine
i. Diabetes
ii. Acromegaly
iii. Thyroid
iv. Parathyroid
d. Hematologic
i. Hemophilia
ii. Sickle Cell
iii. Thalassemia
iv. Leukemia, Myeloma
e. Malignancy
i. Carcinomatous polyarthritis, metastatic
disease
ii. Myositis
iii. Hypertrophic osteoarthropathy

8.

Neoplasms
a. Pigmented Villo Nodular Synovitis (PVNS)
b. Synovial Chondromatosis
c. Synovioma

9.

NeuroVascular
a. Avascular Necrosis (AVN)
b. Neuropathic Arthritis

10. Soft-Tissue Rheumatism

a. Fibromyalgia (FM)
11. Arthritis Associated with Trauma (Burns, frostbite etc)

OTHER DIFFERENTIAL DIAGOSES

ACUTE MONOARTHRITIS
INFECTION
CRYSTALS
RA & VARIANT - Monoarticular onset
SERONEGATIVE - Monoarticular onset
CTD - Monoarticular onset
SYSTEMIC DISEASE - Sarcoidosis
OSTEOARTHRITIS
NEOPLASM
AVASCULAR NECROSIS, NEUROPATHIC JOINT
TRAUMATIC

CHRONIC MONOARTHRITIS
INFECTION - atypical mycobacterium
CRYSTALS
RA & VARIANTS
SERONEGATIVES
CONNECTIVE TISSUE DISEASES
SYSTEMIC DISEASE
OSTEOARTHRITIS
NEOPLASMS
NEUROVASCULAR
TRAUMATIC - resulting instability

ACUTE OLIGOARTHRITIS
INFECTION (gonococcal)
CRYSTALS
RA & VARIANTS - ASD, JIA
SERONEGATIVES
CONNECTIVE TISSUE DISEASES
SYSTEMIC DISEASE - Sarcoidosis

CHRONIC OLIGOARTHRITIS
SERONEGATIVES
CONNECTIVE TISSUE DISEASES
SYSTEMIC DISEASE
OSTEOARTHRITIS
NEUROVASCULAR

ACUTE POLYARTHRITIS
INFECTION (gonococcal & viral)
CRYSTALS - rarely
RA & VARIANTS
SERONEGATIVES (reactive)
CONNECTIVE TISSUE DISEASES
SYSTEMIC DISEASE

CHRONIC POLYARTHRITIS
INFECTION - unusual
CRYSTALS - can mimic RA
RA & VARIANTS
SERONEGATIVES
CONNECTIVE TISSUE DISEASES
SYSTEMIC DISEASE
OSTEOARTHRITIS